Castejón O J
J Neuropathol Exp Neurol. 1980 May;39(3):296-328. doi: 10.1097/00005072-198005000-00006.
Cortical biopsies of 17 patients with diagnoses of congenital malformation, cerebral tumor or brain trauma complicated by subdural hematoma or hygroma were studied with the electron microscope; the alterations of the blood-brain barrier in moderate and severe perifocal cerebral edema were observed. Moderate edema was found associated with central nervous system malformations, while severe edema was seen accompanying brain tumors and serious head injuries. The peripheral cytoplasm of endothelial cells displayed increased formation of microvilli and clear or amorphous electron-dense vacuoles, as well as pinocytotic and coated vesicles. In severe edema, the formation of elongated or chained vacuoles forming transendothelial channels was observed. In moderate edema, endothelial junctions exhibited a tortuous pathway, with a luminal portion sealed by tight junctions and dilated, open, basal portions ending at the basement membrane. In severe edema, the zonulae accludentes partially disappeared and the endothelial junction basal segments became irregularly dilated. The basement membrane showed enlargement, rarefaction, vacuolization, and the presence of collagen fibers. Fine expansion of the basement membrane was distinguished, showing matrix loss and clear, irregularly-dilated channels. Capillaries with reduplicated basement membrane were also observed. The pericytes exhibited edema, vacuolization, and phagocytic activity. In moderate cerebral edema, the clear or dense edematous and vacuolated perivascular end-feet of astrocytes appeared closely applied to the basement membrane, while in severe cerebral edema, they were separated from the basement membrane and showed gradual disappearance of the gap junctions. In all cases, moderately or markedly dilated extracellular spaces were observed in the pericapillary neuropil.
对17例诊断为先天性畸形、脑肿瘤或伴有硬膜下血肿或蛛网膜下腔积液的脑外伤患者的皮质活检组织进行了电子显微镜研究；观察了中度和重度灶周脑水肿中血脑屏障的改变。发现中度水肿与中枢神经系统畸形有关，而重度水肿则伴随脑肿瘤和严重头部损伤出现。内皮细胞的外周细胞质显示微绒毛形成增加，出现透明或无定形的电子致密空泡，以及胞饮泡和有被小泡。在重度水肿中，观察到形成了形成跨内皮通道的细长或链状空泡。在中度水肿中，内皮连接呈现曲折的路径，管腔部分被紧密连接封闭，而基底部分扩张、开放，终止于基底膜。在重度水肿中，紧密连接部分消失，内皮连接基底段不规则扩张。基底膜显示增大、稀疏、空泡化，并存在胶原纤维。区分出基底膜的细微扩张，表现为基质丢失和清晰、不规则扩张的通道。还观察到有重复基底膜的毛细血管。周细胞表现出水肿、空泡化和吞噬活性。在中度脑水肿中，星形胶质细胞清晰或致密的水肿性和空泡化的血管周围终足似乎紧密贴附于基底膜，而在重度脑水肿中，它们与基底膜分离，缝隙连接逐渐消失。在所有病例中，在毛细血管周围神经毡中均观察到中度或明显扩张的细胞外间隙。
